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Évolution de la prise en charge du rétrécissement aortique serré au centre hospitalier départemental de La Roche-sur-Yon, Vendée (2005, 2015 et 2022). Vendee(2005年、2015年和2022年),La Roche-sur-Yon省医院中心主动脉狭窄治疗的演变。
IF 0.3 Q4 Medicine Pub Date : 2025-09-25 DOI: 10.1016/j.ancard.2025.101954
Marine Perion , Jacques Chan Peng , Louen Ropers , Jérôme Dimet , Emmanuel Boiffard , Olivier Baron , Thibaut Manigold , Jean-Christian Roussel , Patrice Guérin , Hervé Pouliquen

Background

Severe calcific aortic stenosis (AS) is the most common valvular heart disease in the elderly and carries a poor prognosis without intervention. The introduction of transcatheter aortic valve implantation (TAVI) in 2002 profoundly reshaped therapeutic strategies. This study aimed to evaluate changes in patient management and outcomes at the Departmental Hospital Center of La Roche‑sur‑Yon over three time periods: 2005 (pre‑TAVI era), 2015 (early TAVI integration), and 2022 (TAVI‑dominant era).

Methods

We conducted a retrospective, single-center observational study including all patients hospitalized for symptomatic severe AS or reduced left ventricular ejection fraction. Clinical characteristics, operative risk scores, management strategies, and one-year outcomes were analyzed.

Results

Between 2005 and 2022, the number of patients managed for SAS increased by 158% (65 in 2005, 136 in 2015, 168 in 2022). Mean age (79 years in 2022) and male proportion (60%) remained stable. Therapeutic strategies shifted markedly (p < 0.001): surgery predominated in 2005 (67%), whereas TAVI became the most frequent treatment in 2022 (55%), followed by surgery (21%) and medical therapy (24%). Surgically treated patients were increasingly selected, with a median EuroSCORE II falling from 3,95 % (2005) to 1.1% (2022). One-year all-cause mortality in 2022 was 0% after surgery, 5.9% after TAVI (down from 28.8% in 2015, p = 0.008), and 68% with medical therapy (p < 0.001). Heart failure rehospitalizations were also more frequent in the medical group (33% vs 6% after TAVI and 2% after surgery; p = 0.016). The proportion of patients not presented at the heart team meeting declined significantly (17% in 2022 vs 35% before 2015; p < 0.001). The waiting times nevertheless remained significant (median of 70 days between admission and the MDT meeting, plus 41 days before the procedure).

Conclusions

Integration of TAVI has profoundly transformed AS management in our center, now the dominant strategy with significantly improved one-year prognosis. Medically treated patients still experience poor outcomes, underscoring the need to reduce delays and streamline the care pathway.
重度钙化性主动脉瓣狭窄(AS)是老年人最常见的瓣膜性心脏病,未经干预预后较差。2002年引入的经导管主动脉瓣植入术(TAVI)深刻地重塑了治疗策略。本研究旨在评估La Roche - sur - Yon部门医院中心在三个时间段内患者管理和结果的变化:2005年(前TAVI时代),2015年(早期TAVI整合)和2022年(TAVI主导时代)。方法我们进行了一项回顾性、单中心观察性研究,纳入了所有因症状性严重AS或左室射血分数降低而住院的患者。分析临床特征、手术风险评分、管理策略和一年的结果。结果2005年至2022年,接受SAS治疗的患者数量增加了158%(2005年65人,2015年136人,2022年168人)。平均年龄(2022年79岁)和男性比例(60%)保持稳定。治疗策略发生了显著变化(p < 0.001):手术在2005年占主导地位(67%),而TAVI在2022年成为最常见的治疗方法(55%),其次是手术(21%)和药物治疗(24%)。手术治疗的患者越来越多地被选择,中位EuroSCORE II从3.95%(2005年)下降到1.1%(2022年)。2022年手术后一年全因死亡率为0%,TAVI后为5.9%(低于2015年的28.8%,p = 0.008),药物治疗后为68% (p < 0.001)。内科组的心力衰竭再住院率也更高(33% vs TAVI后的6%,手术后的2%;p = 0.016)。未出席心脏小组会议的患者比例显著下降(2022年为17%,2015年为35%;p < 0.001)。然而,等待时间仍然很长(从入院到MDT会议的中位数为70天,加上手术前41天)。结论TAVI的整合已经深刻地改变了我中心AS的管理,现在是主导策略,显著改善了1年预后。接受过医疗治疗的患者的预后仍然很差,这凸显了减少延误和简化护理途径的必要性。
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引用次数: 0
Fibrillation atriale révélatrice d’un hyperaldostéronisme primaire : à propos d’un cas 原发性醛固酮升高的房颤:关于一个病例
IF 0.3 Q4 Medicine Pub Date : 2025-09-24 DOI: 10.1016/j.ancard.2025.101952
Hind Hibatouallah , Mohamed Mehdi Guedira , Selma Siagh , Asmae Benssied , Youssef Fihri , Zouhair Lakhal , Aatif Benyass
Primary hyperaldosteronism is the most common cause of secondary hypertension, with a prevalence estimated between 5% and 15%. Despite this, it remains largely underdiagnosed due to often non-specific clinical manifestations and insufficient screening. However, primary hyperaldosteronism is associated with significantly higher cardiovascular morbidity and mortality compared to essential hypertension, regardless of blood pressure levels and usual cardiac remodeling. Recent studies have highlighted a direct link between primary hyperaldosteronism and atrial fibrillation—the most common sustained arrhythmia in adults—associated with increased cardiovascular risk. This connection is partly explained by the direct involvement of the renin-angiotensin-aldosterone system in the pathophysiology of this arrhythmia.
We report the case of a patient with moderate hypertension, persistent hypokalemia, and unexplained atrial fibrillation. The absence of hemodynamic impact on echocardiography and the exclusion of classical etiologies of atrial fibrillation led to the suspicion of primary hyperaldosteronism. Hormonal testing confirmed the diagnosis of primary hyperaldosteronism due to a Conn's adenoma. A laparoscopic adrenalectomy was performed, with favorable outcomes.
This case highlights the often underestimated association between primary hyperaldosteronism and atrial fibrillation, and emphasizes the importance of targeted screening in hypertensive patients with unexplained atrial fibrillation, to optimize management and improve cardiovascular prognosis.
L’hyperaldostéronisme primaire est la cause la plus fréquente d’hypertension artérielle secondaire, avec une prévalence estimée entre 5 et 15 %. Malgré cela, il reste largement sous-diagnostiqué, en raison de manifestations cliniques souvent peu spécifiques et d’un dépistage encore insuffisant. Cependant, l’hyperaldostéronisme primaire est associé à une morbidité et une mortalité cardiovasculaires significativement plus élevées que l’hypertension artérielle essentielle, indépendamment des chiffres tensionnels et des remaniements cardiaques habituels. Des études récentes ont mis en évidence un lien direct entre l’ hyperaldostéronisme primaire et la fibrillation atriale, principale arythmie soutenue de l’adulte, associée à une augmentation du risque cardiovasculaire. Ceci s’explique notamment par l’implication directe du système rénine-angiotensine-aldostérone dans la physiopathologie de cette arythmie.
Nous rapportons le cas d’un patient présentant une hypertension artérielle modérée, une hypokaliémie persistante et une fibrillation atriale inexpliquée. L’absence de retentissement hémodynamique à l’échocardiographie, ainsi que l’exclusion des étiologies classiques de la fibrillation atriale, ont conduit à suspecter un hyperaldostéronisme primaire. Le bilan hormonal a confirmé le diagnostic d’ hyperaldostéronisme primaire en rapport avec un adénome d
原发性高醛固酮增多症是继发性高血压最常见的原因,患病率估计在5%至15%之间。尽管如此,由于非特异性临床表现和筛查不足,该病在很大程度上仍未得到充分诊断。然而,与原发性高血压相比,原发性高醛固酮增多症的心血管发病率和死亡率明显更高,无论血压水平和通常的心脏重构如何。最近的研究强调了原发性高醛固酮增多症和房颤之间的直接联系,房颤是成人中最常见的持续性心律失常,与心血管风险增加有关。肾素-血管紧张素-醛固酮系统直接参与这种心律失常的病理生理,部分解释了这种联系。我们报告的病例患者中度高血压,持续低钾血症,和不明原因的心房颤动。超声心动图没有血流动力学影响,排除房颤的经典病因,导致怀疑原发性高醛固酮增多症。激素检查证实原发性醛固酮增多症是由Conn腺瘤引起的。行腹腔镜肾上腺切除术,效果良好。本病例强调了原发性高醛固酮增多症与房颤之间常被低估的相关性,并强调了对伴有不明原因房颤的高血压患者进行针对性筛查的重要性,以优化管理,改善心血管预后。原发性高血压病与原发性高血压病合并为原发性高血压病和继发性高血压病合并为原发性高血压病,平均为原发性高血压病和原发性高血压病合并为原发性高血压病。malgraise,将停止大规模的诊断,在临床表现上的理由是,没有充分的证据表明,没有充分的证据表明,没有充分的证据表明,没有充分的证据。因此,高胆固醇与主要的心血管疾病相关,如发病率、死亡率、心血管疾病的显著性,以及高血压与基本的心血管疾病相关,如高血压、高血压和心血管疾病相关。该组织的主要研究对象是成年患者,主要研究对象是成年患者,主要研究对象是成年患者,主要研究对象是成年患者。杜塞西解释尤其是par l 'implication流转systeme renine-angiotensine-aldosterone在physiopathologie de这个arythmie。目前的病例包括:1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有高血压,1例患者患有慢性高血压,1例患者患有心房纤颤,1例患者患有不明原因的高血压。没有保留的情况下,有 的, 的: 的,不排除的, 的,不排除的,的,不排除的。Le bilan贺尔蒙证实,Le Le诊断为高变性者,原发于高变性者,原发于高变性者,原发于高变性者,原发于高变性者,原发于高变性者,原发于高变性者。研究结果表明:高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与慢性心血管患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与慢性心血管患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比,高血压患者与高血压患者相比。
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引用次数: 0
Le Strain réservoir de l’oreillette gauche dans l’accident vasculaire cérébral ischémique The left atrial reservoir strain in ischemic stroke 左脑缺血性中风左心房缺血性中风左心房缺血性中风
IF 0.3 Q4 Medicine Pub Date : 2025-09-23 DOI: 10.1016/j.ancard.2025.101951
Amina Maamri , Sabrina Denden , Meriem Mediouni , Amine Bejar , Thibault Guitteny , Mourad Bouayed , Sara Hezili , Nada Tababi , Sihem Mbarki , Taha Hassani , Hakim Gourari , Frederic Ghawche , Vincent Lefebvre
<div><h3>Introduction</h3><div>La recherche d’une source cardiaque potentielle est une étape fondamentale dans l’évaluation urgente d’un accident vasculaire cérébral ischémique (AVCI), dont la principale cause est la fibrillation atriale (FA). Des études récentes ont prouvé la supériorité de l’évaluation de la fonction atrial gauche par la méthode de Speckle-Tracking versus les dimensions de l’oreillette gauche (OG) comme prédicteur de FA paroxystique. L’altération du strain réservoir (SR) de l’OG est associée à l’incidence des AVCI.</div></div><div><h3>Méthodes</h3><div>Etude rétrospective, observationnelle chez des patients hospitalisés dans le service de neurologie, de janvier 2022 à avril 2023 pour accident vasculaire cérébral ischémique constitué ou transitoire, sans fibrillation atriale connue ni traitement anticoagulant préalable. Les objectifs de l’étude étaient la recherche 1) d’une association entre le SR et l’origine embolique de l’AVCI, avec identification des facteurs associés aux AVCI ; 2) d’une association entre le SR et la survenue de fibrillation atriale, avec identification des facteurs associés à l’altération du SR.</div></div><div><h3>Résultats</h3><div>L’étude a inclus 79 patients (56% d’hommes, âge médian 72 ans), 39% des AVCI étaient cryptogéniques (dont 26% sont transitoires), 23 % cardio-embolique et 14% emboliques d’origines indéterminées (ESUS). Parmi les causes cardio-embolique (18 patients), 33% étaient secondaires à une fibrillation atriale, 39 à un foramen ovale perméable (FOP). Le SR médian était de 27%, le SR était < 39% dans 86% des cas, que l’oreillette gauche soit dilatée ou non. Avec un seuil de 20% et une valeur de P à 0,01, le SR était associé à l’origine embolique de l’AVCI (groupe FOP exclu). Le SR < 20% était associé à la survenue de FA dans le suivi (P= 0,04).</div></div><div><h3>Conclusion</h3><div>Notre étude suggère qu’un strain réservoir de l’oreillette gauche < 20% à la phase aigue d’un AVCI/AIT, chez des patients sans antécédent de fibrillation atriale ni traitement anticoagulant, pourrait être associé à l’origine embolique de l’AVCI et à la survenue de fibrillation atriale dans le suivi.</div></div><div><h3>Background</h3><div>The search for a potential cardiac source is a fundamental step in the urgent evaluation of an ischaemic stroke (IS) or Transient ischemic attack (TIA). The most common cardioembolic cause of IS is atrial fibrillation (AF). Analysis of the left atrial function is superior to left atrial (LA) dimensions measurements as predictor of paroxysmal AF, especially with the study of deformation anomalies using 2D Speckle-Tracking. Alteration of the reservoir strain (RS) of the LA is associated with the incidence of IS.</div></div><div><h3>Methods</h3><div>Retrospective observational study in patients hospitalised in the neurology departement from January 2022 to April 2023, for IS or TIA, with no history of AF nor anticoagulation treatment. The objectives of the study were t
寻找潜在的心脏源是缺血性中风(缺血性中风)紧急评估的基本步骤,缺血性中风的主要原因是房颤(房颤)。最近的研究证明,与左耳尺寸(OG)相比,用斑点跟踪法评估左心房功能作为发作性FA的预测器具有优势。OG菌株库(SR)的改变与CVA的发病率有关。方法对2022年1月至2023年4月在神经内科住院的患者进行回顾性观察性研究,研究对象为没有已知房颤或事先抗凝治疗的形成性或暂时性缺血性中风患者。本研究的目的是寻找1)SR与ICAD的象征起源之间的联系,并确定与ICAD相关的因素;2)之间有一个协会的SR和治疗房颤的发生与鉴别SR.RésultatsL’étude风化的相关因素,包括了79名患者(56%的男性,平均年龄72岁),有39%的AVCI cryptogéniques(其中26%),23% cardio-embolique过渡性和不明来源的emboliques (ESUS 14%)。在心脏栓塞病因(18例)中,33%为房颤继发,39为卵巢通孔(FOP)继发。中位SR为27%,86%的病例中SR为39%,无论左耳廓是否扩张。阈值为20%,P值为0.01,SR与CVID的栓塞起源有关(不包括FOP组)。20%的LR与随访中FA的发生有关(P= 0.04)。结论:我们的研究表明,在没有房颤史或抗凝治疗的患者中,急性ICD / ITD中20%的左耳膜紧张储层可能与房颤的栓塞起源和随访中房颤的发生有关。寻找潜在的心脏源是缺血性中风(IS)或暂时性缺血性发作(TIA)紧急评估的基本步骤。心肌梗死最常见的原因是心房纤颤(AF)。左心室功能的分析优于左心室(LA)尺寸测量作为发作性AF的预测,特别是在使用2D斑点跟踪研究畸形异常时。洛杉矶水库菌株(RS)的改变与IS的发病率有关。方法:对2022年1月至2023年4月在神经内科住院的无AF或抗凝治疗史的IS或TIA患者的回顾性观察研究。这项研究的目的是调查1)RS与IS的栓塞起源(心脏栓塞和ESUS)之间的联系,确定与IS相关的因素;2) RS与房颤发生之间的关联,识别与RS缺陷相关的因素20%。该研究包括79例患者(56%为男性,中位年龄72岁),39%的缺血性中风是隐源性的(其中26%是暂时性的),23%是心脏栓塞性的,14%是来源不明的栓塞性的。在心脏栓塞的原因(18例)中,33%为房颤继发,39%为卵巢专利孔(PFO)继发。无论左中庭是否扩张,86%的病例中,中位RS为27%,中位RS为39%。阈值为20%,P值为0.01,RS与脑卒中的栓塞起源有关(不包括全氟辛烷磺酸组)。随访期间,20%的RS与房颤的发生相关(P= 0.04)。ConclusionOur study suggests that a的水库体格of the left atrium < 20%的急性阶段during the of an ischemic她/ transient ischemic遭袭,病人in without a history of atrial房颤抗凝剂治疗,黄金may be associated with an embolic origin of the上了她的ischemic and the of atrial发生房颤during后续活动。
{"title":"Le Strain réservoir de l’oreillette gauche dans l’accident vasculaire cérébral ischémique The left atrial reservoir strain in ischemic stroke","authors":"Amina Maamri ,&nbsp;Sabrina Denden ,&nbsp;Meriem Mediouni ,&nbsp;Amine Bejar ,&nbsp;Thibault Guitteny ,&nbsp;Mourad Bouayed ,&nbsp;Sara Hezili ,&nbsp;Nada Tababi ,&nbsp;Sihem Mbarki ,&nbsp;Taha Hassani ,&nbsp;Hakim Gourari ,&nbsp;Frederic Ghawche ,&nbsp;Vincent Lefebvre","doi":"10.1016/j.ancard.2025.101951","DOIUrl":"10.1016/j.ancard.2025.101951","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;La recherche d’une source cardiaque potentielle est une étape fondamentale dans l’évaluation urgente d’un accident vasculaire cérébral ischémique (AVCI), dont la principale cause est la fibrillation atriale (FA). Des études récentes ont prouvé la supériorité de l’évaluation de la fonction atrial gauche par la méthode de Speckle-Tracking versus les dimensions de l’oreillette gauche (OG) comme prédicteur de FA paroxystique. L’altération du strain réservoir (SR) de l’OG est associée à l’incidence des AVCI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Méthodes&lt;/h3&gt;&lt;div&gt;Etude rétrospective, observationnelle chez des patients hospitalisés dans le service de neurologie, de janvier 2022 à avril 2023 pour accident vasculaire cérébral ischémique constitué ou transitoire, sans fibrillation atriale connue ni traitement anticoagulant préalable. Les objectifs de l’étude étaient la recherche 1) d’une association entre le SR et l’origine embolique de l’AVCI, avec identification des facteurs associés aux AVCI ; 2) d’une association entre le SR et la survenue de fibrillation atriale, avec identification des facteurs associés à l’altération du SR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Résultats&lt;/h3&gt;&lt;div&gt;L’étude a inclus 79 patients (56% d’hommes, âge médian 72 ans), 39% des AVCI étaient cryptogéniques (dont 26% sont transitoires), 23 % cardio-embolique et 14% emboliques d’origines indéterminées (ESUS). Parmi les causes cardio-embolique (18 patients), 33% étaient secondaires à une fibrillation atriale, 39 à un foramen ovale perméable (FOP). Le SR médian était de 27%, le SR était &lt; 39% dans 86% des cas, que l’oreillette gauche soit dilatée ou non. Avec un seuil de 20% et une valeur de P à 0,01, le SR était associé à l’origine embolique de l’AVCI (groupe FOP exclu). Le SR &lt; 20% était associé à la survenue de FA dans le suivi (P= 0,04).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Notre étude suggère qu’un strain réservoir de l’oreillette gauche &lt; 20% à la phase aigue d’un AVCI/AIT, chez des patients sans antécédent de fibrillation atriale ni traitement anticoagulant, pourrait être associé à l’origine embolique de l’AVCI et à la survenue de fibrillation atriale dans le suivi.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The search for a potential cardiac source is a fundamental step in the urgent evaluation of an ischaemic stroke (IS) or Transient ischemic attack (TIA). The most common cardioembolic cause of IS is atrial fibrillation (AF). Analysis of the left atrial function is superior to left atrial (LA) dimensions measurements as predictor of paroxysmal AF, especially with the study of deformation anomalies using 2D Speckle-Tracking. Alteration of the reservoir strain (RS) of the LA is associated with the incidence of IS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Retrospective observational study in patients hospitalised in the neurology departement from January 2022 to April 2023, for IS or TIA, with no history of AF nor anticoagulation treatment. The objectives of the study were t","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 5","pages":"Article 101951"},"PeriodicalIF":0.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
DOME-HF : évaluation rétrospective sur six mois de la prise en charge diurétique ambulatoire chez des patients âgés atteints d’insuffisance cardiaque DOME-HF:对老年心力衰竭患者门诊利尿剂管理的6个月回顾性评估
IF 0.3 Q4 Medicine Pub Date : 2025-09-22 DOI: 10.1016/j.ancard.2025.101933
Marlène Esteban , Olivier Maurou , Marc Harboun , Sophie Nisse Durgeat , Rémi Esser

Introduction

Heart failure (HF) is a major cause of morbidity and mortality in older adults, with a rising prevalence after the age of 70. Conventional hospitalization, commonly required in this frail population, exposes patients to numerous iatrogenic complications. Alternative care models, such as diuretic-based day hospital (DH) management, may help mitigate these risks.

Objectives

To describe the geriatric profile of patients treated for acute heart failure (AHF) in a diuretic day hospital within a cardiogeriatrics unit, and to report the organization of the associated care pathway.

Methods

This was a retrospective, observational, monocentric study conducted in the cardiogeriatrics department of Hôpital La Porte Verte (Versailles, France). Patients aged ≥65 years who were treated in a diuretic day hospital for acute heart failure between January and June 2025 were included. Geriatric, cardiologic, and organizational data were collected from medical records. A purely descriptive analysis was performed.

Results

Forty patients were included, with a mean age of 88 ± 6.8 years. Most lived at home (95%) and had preserved autonomy (mean ADL score: 5.4). The average Charlson Comorbidity Index was 8.9 ± 2.3; 50% were at risk of malnutrition and 92.5% had chronic kidney disease. From a cardiologic standpoint, 57.5% had preserved LVEF and 67.5% had atrial fibrillation. The mean delay between referral and the first day hospital session was 1.6 days, with an average of 3.1 sessions per patient. The rate of subsequent full hospitalization was 12.5%. Main complications included electrolyte disorders (5%), non-catheter-related infections (7.5%), and acute kidney injury (7.5%). Following day hospital management, 22.5% of patients were enrolled in a geriatric frailty day hospital program, 32.5% in an intravenous iron day hospital, and 22.5% in a remote monitoring program.

Conclusion

This diuretic day hospital model, integrated into a structured geriatric care pathway, appears feasible, safe, and relevant for managing very elderly patients with acute heart failure. It may represent an effective alternative to conventional hospitalization.
心衰(HF)是老年人发病和死亡的主要原因,70岁以后患病率上升。传统的住院治疗,通常需要在这个虚弱的人群,使患者暴露于许多医源性并发症。替代护理模式,如以利尿剂为基础的日间医院(DH)管理,可能有助于减轻这些风险。目的描述急性心力衰竭(AHF)患者在一家利尿日间医院的老年内科治疗的老年特征,并报告相关护理途径的组织。方法:这是一项回顾性、观察性、单中心研究,在Hôpital La Porte Verte (Versailles, France)心脏科进行。纳入2025年1月至6月期间在利尿日间医院治疗急性心力衰竭的年龄≥65岁的患者。从医疗记录中收集老年、心脏病和组织数据。进行了纯描述性分析。结果入选患者40例,平均年龄88±6.8岁。大多数人(95%)住在家里,并保持了自主性(平均ADL评分:5.4)。平均Charlson合并症指数为8.9±2.3;50%的人有营养不良的危险,92.5%的人患有慢性肾病。从心脏病学的角度来看,57.5%的患者保留了LVEF, 67.5%的患者有心房颤动。从转诊到第一天住院之间的平均延迟为1.6天,平均每位患者为3.1次。随后完全住院率为12.5%。主要并发症包括电解质紊乱(5%)、非导管相关感染(7.5%)和急性肾损伤(7.5%)。在日间医院管理之后,22.5%的患者入组了老年虚弱日间医院项目,32.5%入组了静脉注射铁日间医院项目,22.5%入组了远程监测项目。结论:将这种利尿剂日间医院模式整合到一个结构化的老年护理路径中,似乎是可行的、安全的,并且与管理高龄急性心力衰竭患者相关。它可能是传统住院治疗的一种有效替代方法。
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引用次数: 0
Safety of exercise training for cardiac patients : results of a French multicenter COCARE study (COmplications in CArdiac REhabilitation) 运动训练对心脏病患者的安全性:一项法国多中心COCARE研究结果(心脏康复并发症)
IF 0.3 Q4 Medicine Pub Date : 2025-09-22 DOI: 10.1016/j.ancard.2025.101940
Bruno Pavy , Marie-Christine Iliou , Mohamed Ghannem , Dany Marcadet , Warner Mampuya

Background

Cardiac rehabilitation is widely recognized as beneficial for patients with coronary artery disease, post-cardiac surgery, and heart failure, although it is underutilized. However, the benefit-risk balance must be updated to reflect the evolving characteristics of treated populations.

Objective

To evaluate the safety of supervised exercise training in a large sample of French cardiac rehabilitation patients, and to assess the utility of the modified Risk of Activity Related Events (RARE) score in identifying low-risk individuals.

Methods

This multicenter observational study included 6,793 patients from 32 centers surveyed between 2023 and 2025. Each center collected data over four consecutive months, including patient characteristics and events that interrupted programs, required transfer to acute care, or resulted in rehabilitation cessation. The modified RARE score was applied to identify a low-risk subgroup. Events were considered activity-related if they occurred during or within one hour of a training session.

Results

A total of 964 events (14.2%) were reported, of which 154 (2.3%) were activity-related. Two cardiac arrests occurred—one fatal—representing 0.98 cardiac arrests and 0.49 deaths per 100,000 patient-hours of training. A modified RARE score < 4 defined a low-risk group with an area under the ROC curve of 0.67 and an excellent negative predictive value (0.99). However, specificity was limited (0.32), reflecting the low incidence of events even in high-risk patients.

Conclusion

The COCARE study confirms the low risk of supervised exercise in phase II cardiac rehabilitation. The modified RARE score may be useful in identifying patients who could safely benefit from alternative, less monitored formats such as telerehabilitation.
背景:心脏康复被广泛认为对冠状动脉疾病、心脏手术后和心力衰竭患者有益,尽管它尚未得到充分利用。然而,必须更新利益-风险平衡,以反映治疗人群不断变化的特征。目的评估法国心脏康复患者大样本中监督运动训练的安全性,并评估改进的活动相关事件风险(RARE)评分在识别低风险个体中的效用。该多中心观察性研究纳入了来自32个中心的6793例患者,调查时间为2023年至2025年。每个中心收集了连续四个月的数据,包括患者的特征和中断项目的事件,需要转到急性护理,或导致康复停止。采用改良的RARE评分来确定低风险亚组。如果事件发生在训练期间或一小时内,则被认为与活动有关。结果共报告964例(14.2%),其中运动相关154例(2.3%)。发生了两次心脏骤停,其中一次是致命的,这意味着每10万患者小时的训练中有0.98次心脏骤停和0.49次死亡。修改后的RARE评分<; 4定义为低风险组,ROC曲线下面积为0.67,极好的阴性预测值(0.99)。然而,特异性有限(0.32),反映了即使在高危患者中事件的发生率也很低。结论COCARE研究证实了监督运动在二期心脏康复中的低风险。修改后的RARE评分可能有助于确定哪些患者可以安全地受益于其他较少监测的形式,如远程康复。
{"title":"Safety of exercise training for cardiac patients : results of a French multicenter COCARE study (COmplications in CArdiac REhabilitation)","authors":"Bruno Pavy ,&nbsp;Marie-Christine Iliou ,&nbsp;Mohamed Ghannem ,&nbsp;Dany Marcadet ,&nbsp;Warner Mampuya","doi":"10.1016/j.ancard.2025.101940","DOIUrl":"10.1016/j.ancard.2025.101940","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac rehabilitation is widely recognized as beneficial for patients with coronary artery disease, post-cardiac surgery, and heart failure, although it is underutilized. However, the benefit-risk balance must be updated to reflect the evolving characteristics of treated populations.</div></div><div><h3>Objective</h3><div>To evaluate the safety of supervised exercise training in a large sample of French cardiac rehabilitation patients, and to assess the utility of the modified Risk of Activity Related Events (RARE) score in identifying low-risk individuals.</div></div><div><h3>Methods</h3><div>This multicenter observational study included 6,793 patients from 32 centers surveyed between 2023 and 2025. Each center collected data over four consecutive months, including patient characteristics and events that interrupted programs, required transfer to acute care, or resulted in rehabilitation cessation. The modified RARE score was applied to identify a low-risk subgroup. Events were considered activity-related if they occurred during or within one hour of a training session.</div></div><div><h3>Results</h3><div>A total of 964 events (14.2%) were reported, of which 154 (2.3%) were activity-related. Two cardiac arrests occurred—one fatal—representing 0.98 cardiac arrests and 0.49 deaths per 100,000 patient-hours of training. A modified RARE score &lt; 4 defined a low-risk group with an area under the ROC curve of 0.67 and an excellent negative predictive value (0.99). However, specificity was limited (0.32), reflecting the low incidence of events even in high-risk patients.</div></div><div><h3>Conclusion</h3><div>The COCARE study confirms the low risk of supervised exercise in phase II cardiac rehabilitation. The modified RARE score may be useful in identifying patients who could safely benefit from alternative, less monitored formats such as telerehabilitation.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 5","pages":"Article 101940"},"PeriodicalIF":0.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Vers un modèle national de télésurveillance en insuffisance cardiaque : proposition d'un cadre organisationnel à partir d'un consensus infirmier ville-hôpital 建立全国心脏衰竭监测模式:基于医患共识的组织框架建议
IF 0.3 Q4 Medicine Pub Date : 2025-09-20 DOI: 10.1016/j.ancard.2025.101929
Christine Lecerf , Gauthier Lefranc , Nathalie Vionnet , Valérie Ple , Emilie Saunier , Céline Picard , Céline Chauveau , Nawel Aouni
Remote monitoring of heart failure is now being deployed throughout France. It allows for effective remote monitoring and aims to improve patients' quality of life. Given the heterogeneity of practices, a committee of nurses has proposed a structured and reproducible organizational framework based on four pillars: Engage, Personalize, Support, and Coordinate.
This model encourages the standardization of practices, improves patient adherence, and ensures quality follow-up. Remote monitoring must remain temporary, educational, and patient-centered. Indicators must be used to assess its effectiveness.
心力衰竭的远程监测目前正在法国各地部署。它允许有效的远程监控,旨在提高患者的生活质量。鉴于实践的异质性,一个护士委员会提出了一个基于四个支柱的结构化和可复制的组织框架:参与、个性化、支持和协调。这种模式鼓励实践的标准化,提高患者的依从性,并确保高质量的随访。远程监测必须保持临时性、教育性和以患者为中心。必须使用指标来评估其有效性。
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引用次数: 0
Experiment of Read’Hy : A hybrid, mix of home and centre, cardiac rehabilitation program Read 'Hy实验:一个家庭和中心的混合心脏康复计划
IF 0.3 Q4 Medicine Pub Date : 2025-09-20 DOI: 10.1016/j.ancard.2025.101937
Sonia Corone , Romain Carpentier David , Christelle Pierre , Céline Chouhan , Titi Farrokhi , Aude Brucker , Romain Dorange , Pascal Guillo , Antoine Faure , Annie Fouard

Introduction

Despite the strong recommendations and obvious benefits, cardiac rehabilitation remains underutilised or is often discontinued in real‐world practice. To improve patient care, a hybrid (mix of home and centre) program (Read'Hy) has been developed, combining exercise training sessions and therapeutic education, with weekly face-to-face follow-up.

Methods

After a check-up and minimum five days initiation in the centre, patients returned home, equipped with a heart rate monitor and a mobile application. A personalised 10-week program was drawn up. Asynchronous home exercise was recorded and analysed daily by the rehabilitation technician. Each week, the patient came back to the centre for a supervised training session and interviews allowing to adjust the program.

Results

Out of 353 patients (mean age 55±11 years), 89% completed the program with 91% attendance and 35 physical activity sessions performed. Peak VO2 increased by 20% (21.8 to 26.1 ml/min/kg, p<0.0001), as did VO2 at point of intersection (16.6 to 19.9 ml/min/kg, p<0.0001) and maximum workload (140 to 168 Watts, p<0.0001). Only one rhythmic event was reported. Quality of life improved (VAS +14%, p<0.0001), and weekly physical activity quantified by IPAQ-SF increased by 53% (p<0.0001). After one year, IPAQ-SF remained 43.6% higher than the initial level (p<0.0001).

Conclusion

This hybrid program, both safe and effective, promotes the sustainable integration of physical activity into daily life.
尽管有强烈的建议和明显的益处,心脏康复仍然没有得到充分利用,或者在现实世界的实践中经常停止。为了改善病人的护理,一个混合(家庭和中心的混合)项目(Read'Hy)已经开发出来,结合运动训练课程和治疗教育,每周面对面的随访。方法患者在中心接受检查和至少5天的开始治疗后,带着心率监测仪和移动应用程序返回家中。他们制定了一个为期10周的个性化计划。每天由康复技师记录和分析非同步家庭运动。每周,患者回到中心接受有监督的培训课程和面试,以便调整计划。结果在353例患者(平均年龄55±11岁)中,89%的患者完成了该计划,91%的患者参加了该计划,并进行了35次体育锻炼。峰值VO2增加了20%(21.8至26.1 ml/min/kg, p<0.0001),交叉点的VO2(16.6至19.9 ml/min/kg, p<0.0001)和最大工作负荷(140至168瓦,p<0.0001)也是如此。只有一个有节奏的项目被报道。生活质量得到改善(VAS +14%, p<0.0001), IPAQ-SF量化的每周体力活动增加53% (p<0.0001)。一年后,IPAQ-SF仍比初始水平高43.6% (p<0.0001)。结论:该混合方案安全有效,促进了体育活动与日常生活的可持续结合。
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引用次数: 0
Implantation de stimulateurs cardiaques sans sonde : plaidoyer pour un élargissement des conditions d’implantation dans les centres sans chirurgie cardiaque 无导管心脏起搏器的植入:呼吁扩大无心脏手术中心的植入条件
IF 0.3 Q4 Medicine Pub Date : 2025-09-20 DOI: 10.1016/j.ancard.2025.101941
Walid Amara , Anas El Mahi , Ahmed Salhi , Pierre Socié , Cyrus Moini , Jérôme Taieb
Leadless pacemakers’ implantations in France are limited to centers with onsite cardiac surgery. However, these implantations are now possible in centers without onsite surgery in most European countries. Indeed, the rates of tamponade and cardiac perforation are very low. This article argues for the implantation conditions to be extended to centers with thoracic or vascular surgery (and not cardiac), as is the case for atrial fibrillation ablations, because these centers already have immediate surgical back-up, allowing the treatment of cardiac tamponade or perforation.
在法国,无铅心脏起搏器的植入仅限于有现场心脏手术的中心。然而,在大多数欧洲国家,这些植入物现在可以在中心进行,而无需现场手术。事实上,心包填塞和心脏穿孔的发生率非常低。本文主张将植入条件扩展到胸外科或血管手术中心(而不是心脏),就像心房纤颤消融的情况一样,因为这些中心已经有立即的手术支持,可以治疗心脏填塞或穿孔。
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引用次数: 0
Évaluation du strain de l’oreillette gauche en échocardiographie : intérêt physiopathologique, diagnostique et pronostic 超声心动图左心绞痛评估:生理病理意义、诊断和预后
IF 0.3 Q4 Medicine Pub Date : 2025-09-20 DOI: 10.1016/j.ancard.2025.101934
Patrick Meimoun, Karina Rahmouni, Ines Idir, Vanessa Kacy, Houssam Louhani, Jérome Clerc
Several studies have evaluated left atrial function, mainly using two-dimensional longitudinal myocardial strain with the speckle tracking technique. The study of left atrial strain (LAS) allows the analysis of the different phases of left atrial function (reservoir, conduit, pump) and its correlations with left ventricular systolic and diastolic function, and exercise capacity. Furthermore, LAS has diagnostic value in estimating left ventricular diastolic dysfunction and filling pressure. It helps differentiate the etiologies of left ventricular hypertrophy and has prognostic value in various diseases, including heart failure, valvular diseases, coronary artery disease, atrial fibrillation, and various causes of left ventricular hypertrophy. In this review, we will focus on these topics and discuss the growing interest in three-dimensional LAS.
一些研究评估了左心房功能,主要是利用二维纵向心肌应变与斑点跟踪技术。左心房应变(LAS)的研究可以分析左心房功能(贮、管、泵)的不同阶段及其与左心室收缩、舒张功能和运动能力的相关性。此外,LAS在估计左室舒张功能障碍和充盈压力方面具有诊断价值。它有助于区分左心室肥厚的病因,并对各种疾病有预后价值,包括心力衰竭、瓣膜疾病、冠状动脉疾病、心房颤动和各种原因的左心室肥厚。在这篇综述中,我们将重点讨论这些主题,并讨论对三维LAS日益增长的兴趣。
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引用次数: 0
Fibrose endomyocardique biventriculaire mimant une endocardite infectieuse 模拟感染性心内膜炎的双心室肌内纤维化
IF 0.3 Q4 Medicine Pub Date : 2025-09-20 DOI: 10.1016/j.ancard.2025.101931
Falah Aboukhoudir , Karim Moussa , Sami Rahmani , Safia Chebrek , Sofiene Rekik , Alexandra Dernys
Endomyocardial fibrosis is a rare form of restrictive cardiomyopathy consequent to endocardial damage mediated by hypereosinophilia. It is characterized by fibrous deposits in the ventricular endocardium to a lesser extent, in the myocardium. We report the case of a 75-year-old man having chronic myeloid leukemia in blastic phase, in whom we diagnosed an endomyocardial fibrosis mimicking infective endocarditis. We describe diagnostic modalities and clinical evolution.
心内膜纤维化是一种罕见的限制性心肌病,由嗜酸性粒细胞增多介导的心内膜损伤引起。它的特点是纤维沉积在心室心内膜,在心肌中较少。我们报告的情况下,75岁的男子慢性髓性白血病在母细胞期,我们在其中诊断为心肌内膜纤维化模拟感染性心内膜炎。我们描述了诊断方式和临床演变。
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引用次数: 0
期刊
Annales de cardiologie et d'angeiologie
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